Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

描述(由申请人提供)：本申请是对美国国家酒精滥用和酒精中毒研究所关于预防和治疗药物和酒精滥用的健康服务研究的项目公告PA-05-139的回应，其目标是了解“影响提供酒精或药物滥用预防、治疗和相关服务的因素：社会因素、个人行为和属性、资金、组织、管理和健康技术。”特别是，我们专注于扩大初级保健在预防和治疗酒精和其他药物(AOD)问题方面的作用。我们解决了青少年初级保健提供者使AOD成为卫生保健优先事项的激励和障碍方面的研究差距。我们的目的是确定与青少年AOD使用的筛查做法和管理相关的因素，以便将这些活动更充分地纳入初级保健。我们有机会在一个大型的、不同类型的管理型医疗保健计划中研究这一点。我们使用一个模型，该模型考察了提供者、小组/患者和组织特征对初级保健筛查和后续服务的影响。我们建议对有青少年小组的初级保健提供者进行在线调查，以调查他们的AOD筛查做法，以及他们对筛查和后续干预的障碍和促成因素的看法。这项研究利用了提供者自我报告和健康计划电子数据库的筛查行为以及提供者和小组特征。我们还使用健康计划的电子医疗记录和其他自动数据库来检查报告的和实际的筛查率，以及在确定AOD使用后的提供者做法。我们收集了该区域48个设施的组织特征数据。我们的多变量分析模型检验了设施筛查率的差异，并适当地考虑了设施内提供者的集群。我们还建议与健康计划管理人员和儿科部门的负责人进行访谈，以探索影响筛查做法发展和传播的政策和程序。找出筛查和管理AOD问题的障碍和诱因，可以加强AOD识别和服务在初级保健中的整合。及早发现AOD问题可以预防医疗、化学依赖和精神问题的发展。

DESCRIPTION (provided by applicant): This application responds to the National Institute on Alcohol Abuse and Alcoholism's Program Announcement PA-05-139 Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse, and its goal of understanding "factors that affect the delivery of alcohol or drug abuse prevention, treatment, and related services: social factors, personal behaviors and attributes, financing, organization, management; and health technologies." In particular, we focus on expanding primary care's role in prevention and treatment of alcohol and other drug (AOD) problems. We address the gap in research on incentives and barriers for adolescent primary care providers to make AOD use a health care priority. Our aim is to identify the factors associated with screening practices and management of youth AOD use in order to integrate these activities more fully into primary care. We have the opportunity to study this in a large, heterogeneous managed care health plan. We use a model which examines the influence of provider, panel/patient and organizational characteristics on primary care screening and follow-up services. We propose an on-line survey of primary care providers with adolescent panels to investigate their AOD screening practices, and their perceptions of barriers and enabling factors to screening and follow-up interventions. The study makes use of both provider self-report and health plan electronic databases of screening behavior, and provider and panel characteristics. We also use the health plan's electronic medical record and other automated databases to examine reported and actual screening rates, as well as provider practices after the identification of AOD use. We collect data on organizational characteristics across the region's 48 facilities. Our multivariate analytic model examines facility differences in screening rates and accounts for the clustering of providers within facilities as appropriate. We also propose to conduct interviews with health plan administrators and chiefs, of pediatrics departments to explore policies and procedures as they impact development and dissemination of screening practices. Identifying barriers and incentives to screening and management of AOD problems can heighten integration of AOD identification and services within primary care. Early identification of AOD problems can prevent the development of medical, chemical dependency, and psychiatric problems.